ObjectiveTo evaluate the relationship between recently trained paediatricians' ethics knowledge and exposure to a formal ethics or professionalism curriculum during residency.MethodsWe conducted a cross-sectional survey of recently trained paediatricians which included a validated 23-item instrument called the Test of Residents' Ethics Knowledge for Pediatrics. The sample included paediatricians who completed medical school in 2006–2008, whose primary specialty was paediatrics or a paediatric subspecialty, and who completed paediatric residency training in 2010–2011. This sample was stratified based on residency programme variables: presence (...) of a formal curriculum in ethics or professionalism, programme size and American Board of Pediatrics certifying exam passage rate. Paediatricians were randomly selected from each stratum for survey participation.ResultsAmong the 370 responding paediatricians (55%), the mean knowledge score was 17.3 (SD 2.2) out of a possible 23. Presence of a formal curriculum in ethics and/or professionalism was not significantly associated with knowledge. Knowledge was lowest on items about parental requests for a child to undergo genetic testing (2 items, 44% and 85% incorrect), preserving patient confidentiality over email (55% incorrect), decision-making regarding life-sustaining technologies (61% incorrect), and decision-making principles such as assent and parental permission (2 items, 47% and 49% incorrect).ConclusionsThis study highlights several areas in which paediatricians' knowledge may be low and that are amenable to targeted educational interventions. These findings should prompt discussion and research among ethicists and educators about how ethics and professionalism curricula can more consistently influence paediatricians' knowledge. (shrink)

Ethical codes have been hailed as an explicit vehicle for achieving more sustainable and defensible organizational practice. Nonetheless, when legal compliance and corporate governance codes are conflated, codes can be used to define organizational interests ostentatiously by stipulating norms for employee ethics. Such codes have a largely cosmetic and insurance function, acting subtly and strategically to control organizational risk management and protection. In this paper, we conduct a genealogical discourse analysis of a representative code of ethics from an international corporation (...) to understand how management frames expectations of compliance. Our contribution is to articulate the problems inherent in codes of ethics, and we make some recommendations to address these to benefit both an organization and its employees. In this way, we show how a code of ethics can provide a foundation for ethical sustainability, while addressing management intentions and employees’ ethical satisfaction. (shrink)

According to some philosophers, gender is a social role or pattern of behavior in a social context. I argue that these accounts have problematic implications for transgender. I suggest that gender is a complex behavioral disposition, or cluster of dispositions. Furthermore, since gender norms are culturally relative, one’s gender is partially constituted by extrinsic factors. I argue that this has advantages over thinking of gender as behavior, and has the added advantage of accommodating the possibility of an appearance/reality dissonance with (...) respect to one’s gender. (shrink)

Kant’s Organicism: Epigenesis and the Development of Critical Philosophy, traces the decisive role played by eighteenth century embryological research for Immanuel Kant’s theories of mind and cognition. I begin this book by following the course of life science debates regarding organic generation in England and France between 1650 and 1750 before turning to a description of their influence in Germany in the second half of the eighteenth century. Once this background has been established, the remainder of Kant’s Organicism moves to (...) the influential role played by models of embryological development for Kant’s approach to understanding the cognitive processes responsible for the generation of knowledge, with special attention paid to Kant’s Precritical writings in the 1760s and 1770s. The book closes with a reinterpretation of Kant’s transcendental deduction in the Critique of Pure Reason. (shrink)

Unknowing is at the center of spiritual life. It is only by creating a space in which anything can happen that we allow God to speak; only by stepping back that we allow space for that unpredictable Spirit that brings us gifts beyond any of our imaginings.

Private sector engagement (PSE) is increasingly acknowledged in both literature and practice as a necessary mechanism to sustainably address development challenges. Despite increased practitioner and academic interest in these partnerships, there have been negligible attempts to systematically investigate cross‐sector partnerships to distill best practices from the multiple environments in which they are employed. This manuscript presents a robust review of the social science and business literatures on cross‐sector partnerships, yielding an interdisciplinary, evidence‐based framework detailing archetypes of three prominent partnership characteristics (...) of purpose, context, and relationship enablers. This work integrates a wide range of best practices and values pertinent to businesses and society, enabling researchers, practitioners, and partnership managers to characterize and evaluate partnerships systematically. The introduced framework also enables partners to situate and evaluate their partnership activities to optimize outcomes for each partner and impact on the challenge at hand. (shrink)

This book employs contemporary philosophy, scientific research, and clinical reports to argue that pain, though real, is not an appropriate object of scientific generalisations or an appropriate target for medical intervention. Each pain experience is instead complex and idiosyncratic in a way which undermines scientific utility. In addition to contributing novel arguments and developing a novel position on the nature of pain, the book provides an interdisciplinary overview of dominant models of pain. The author lays the needed groundwork for improved (...) models and targeted treatments at a time when pain science, pain medicine, and philosophy are explicitly searching for both and failing to find them. The Complex Reality of Pain will be of interest to a broad range of researchers and students, including those working in philosophy of mind, philosophy of science, cognitive science, neuroscience, medicine, health, cognitive and behavioural psychology, and pain science. (shrink)

A comprehensive proposal for a conceptual framework for describing conscious experience in dreams, integrating philosophy of mind, sleep and dream research, and interdisciplinary consciousness studies. Dreams, conceived as conscious experience or phenomenal states during sleep, offer an important contrast condition for theories of consciousness and the self. Yet, although there is a wealth of empirical research on sleep and dreaming, its potential contribution to consciousness research and philosophy of mind is largely overlooked. This might be due, in part, to a (...) lack of conceptual clarity and an underlying disagreement about the nature of the phenomenon of dreaming itself. In Dreaming, Jennifer Windt lays the groundwork for solving this problem. She develops a conceptual framework describing not only what it means to say that dreams are conscious experiences but also how to locate dreams relative to such concepts as perception, hallucination, and imagination, as well as thinking, knowledge, belief, deception, and self-consciousness. Arguing that a conceptual framework must be not only conceptually sound but also phenomenologically plausible and carefully informed by neuroscientific research, Windt integrates her review of philosophical work on dreaming, both historical and contemporary, with a survey of the most important empirical findings. This allows her to work toward a systematic and comprehensive new theoretical understanding of dreaming informed by a critical reading of contemporary research findings. Windt's account demonstrates that a philosophical analysis of the concept of dreaming can provide an important enrichment and extension to the conceptual repertoire of discussions of consciousness and the self and raises new questions for future research. (shrink)

In American Nietzsche, Jennifer Ratner-Rosenhagen delves deeply into Nietzsche's philosophy, and America’s reception of it, to tell the story of his curious appeal.

This special issue of Science, Technology, & Human Values assembles papers that consider relations among science, ethics, and justice. The papers are drawn from a 2011 National Science Foundation-sponsored workshop that brought together interdisciplinary scholars to consider, incorporate, and attend to the meanings, uses, and social consequences of ethical questions and justice ideals in technoscientific projects. The papers included in this special issue examine key areas that emerged from this workshop, including public participation, the production of knowledge, what counts as (...) consent, ownership of biomaterials, and others. Together, the papers raise questions about new directions and articulations of power, justice, and inequalities in science and technology studies. (shrink)

What kind of reasons for belief are provided by the testimony of experts? In a world where we are often inundated with fake news, misinformation, and conspiracy theories, this question is more pressing than ever. A prominent view in the philosophical literature maintains that the reasons provided by experts are preemptive in that they normatively screen off, or defeat, other relevant reasons. In this paper, I raise problems for this conception of expertise, including a wholly new one that I call (...) the Problem of the Predatory Expert, which targets both original versions of preemption as well as new, modified ones that aim to avoid some of the standard objections. (shrink)

The Pythagorean tradition dominates the understanding of beauty up until the end of the 18th Century. According to this tradition, the experience of beauty is stimulated by certain relations perceived to be between an object/construct's elements. As such, the object of the experience of beauty is indeterminate: it has neither a determinate perceptual analogue (one cannot simply identify beauty as you can a straight line or a particular shape) nor a determinate concept (there are no necessary and sufficient conditions for (...) beauty at the semantic level). By the 13th Century in the West, the pleasure experienced in beauty is characterized as disinterested. Yet, on the basis that all cultural manifestations of the pythagorean theory of beauty recognize that judgments of beauty are genuine judgments, we would want to say that judgments of beauty are lawful. In addition, from ancient times, up until after Kant, philosophers of beauty within this tradition recognize two kinds of beauty: a universal, unchanging beauty coexisting with a relative, dynamic beauty. These two kinds of beauty and the tensions discussed above, are reconciled and dissolved respectively, according to the metaphysical/religious commitments of the particular author. As yet, however, these features of beauty have not been reconciled within a physicalist worldview. This is what I set out to do. (shrink)

Political corporate social responsibility (PCSR) calls for firms to implement and engage in deliberative democracy processes and structures, addressing governance gaps where governments are unwilling or unable to do so. However, an underlying assumption that the implementation of PCSR will enrich democratic processes in society has been exposed and challenged. In this conceptual article, we explore this challenge by developing a framework to reveal the dynamics of firms’ deliberative democratic processes and structures (meso level), and those at nation state (macro (...) level). Using existing cases as illustrative examples, we demonstrate that despite the public good premise of PCSR theory toward thickening the overall democracy in a society, corporate democratization at meso level can have the opposite effect and may actually erode macro-level democratic control of society and the economy. These findings imply a need for multilevel analysis in PCSR research and greater consideration of state-level public institutions and the responsibilities of business firms toward those institutions. Furthermore, we contribute to the PCSR literature by identifying the disruptive mechanisms associated with these dynamics and outline two alternative perspectives to allow firms to continue to take on political responsibilities. (shrink)

Despite advances in theory, often driven by feminist ethicists, research ethics struggles in practice to adequately account for and respond to the agency and autonomy of people considered vulnerable in the research context. We argue that shifts within feminist research ethics scholarship to better characterise and respond to autonomy and agency can be bolstered by further grounding in discourses from the social sciences, in work that confirms the complex nature of human agency in contexts of structural and other sources of (...) vulnerability. We discuss some of the core concepts and critiques emerging from the literature on women and children's agency in under‐resourced settings, highlighting calls to move from individualistic to relational models of agency, and to recognise the ambiguous, value‐laden, and heterogeneous nature of the concept. We then draw out what these conceptual shifts might mean for research ethics obligations and guidance, illustrating our analysis using a case vignette based on research ethics work conducted in South Africa. We conclude that if research practices are to be supportive of agency, it will be crucial to scrutinise the moral judgements which underpin accounts of agency, derive more situated definitions of and responses to agency, and enable people and participants to influence these based on their own experiences and self‐perceptions. (shrink)

ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)

Most words in English are ambiguous between different interpretations; words can mean different things in different contexts. We investigate the implications of different types of semantic ambiguity for connectionist models of word recognition. We present a model in which there is competition to activate distributed semantic representations. The model performs well on the task of retrieving the different meanings of ambiguous words, and is able to simulate data reported by Rodd, Gaskell, and Marslen‐Wilson [J. Mem. Lang. 46 (2002) 245] on (...) how semantic ambiguity affects lexical decision performance. In particular, the network shows a disadvantage forwords with multiple unrelated meanings (e.g., bark) that coexists with a benefit for words with multiple related word senses (e.g., twist). The ambiguity disadvantage arises because of interference between the different meanings, while the sense benefit arises because of differences in the structure of the attractor basins formed during learning. Words with few senses develop deep, narrow attractor basins, while words with many senses develop shallow, broad basins. We conclude that the mental representations of word meanings can be modelled as stable states within a high‐dimensional semantic space, and that variations in the meanings of words shape the landscape of this space. (shrink)

Disposition terms, such as 'cowardice,' 'fragility' and 'reactivity,' often appear in explanations. Sometimes we explain why a man ran away by saying that he was cowardly, or we explain why something broke by saying it was fragile. Scientific explanations of certain phenomena feature dispositional properties like instability, reactivity, and conductivity. And these look like causal explanations - they seem to provide information about the causal history of various events. Philosophers such as Ned Block, Jaegwon Kim, Elizabeth Prior, Robert Pargetter, and (...) Frank Jacksonl have suggested reasons for thinking that dispositions are causally inert. I call this the "Inert Dispositions View." According to this view, the glass's fragility was not responsible for its breaking; the man's cowardice was causally impotent as he fled. The Inert Dispositions View would call many of the explanations we give into question. By employing a disposition in an explanation, we might have thought we were giving a causal explanation of the event. Perhaps we took ourselves to be explaining an effect with some feature of its cause that was responsible for the effect. However, if dispositions are causally inert, we are explaining the event in some other way, or not really explaining it at all. The Inert Dispositions View suggests that something is amiss with many scientific explanations. If properties like conductivity and volatility are causally inert, it is not clear how appealing to them provides us with information about why certain phenomena occur. This is especially problematic if one thinks, as some do, that the fundamental properties that scientists attribute to the ultimate constituents of matter -- things like force, mass, charge, impenetrability -- are dispositional. If, as Simon Blackburn says, "science finds only dispositional properties all the way down,"2 and if dispositions are causally inert, it would seem that science does not provide us with real causal explanations. The Inert Dispositions View implies that there is something amiss with psychological explanations as well. At least some psychological states are dispositional -- being courageous or shy, being such that you would accept a drink if you were offered one. On some views, all mental states are like dispositions, since having a mental state is a matter of having some brain state or other that performs a certain causal role. If mental properties are relevantly similar to dispositions, and dispositions are inert, then mental properties make no difference to what a body does. However, it is natural to think that my believing and desiring certain things has much to do with my body moving in certain ways. It would take powerful arguments to cast these beliefs into serious doubt. In this paper, I defend the causal efficacy of dispositions against two types of arguments that l call "Analyticity Arguments" and "No Work Arguments." According to Analyticity Arguments, there is an analytic or necessary connection between a disposition and its manifestation, and this goes to show that there is no causal connection. I argue, on the contrary, that it shows no such thing. According to No Work arguments, manifestations of dispositions already have sufficient causes, and so there is "no work" for dispositions to do. I claim that these arguments rest on some questionable assumptions. (shrink)

There is growing interest in the processes by which entrepreneurial opportunities are cocreated between entrepreneurs and their stakeholders. The longitudinal case study of de novo firm Wakefield Seafoods seeks to understand the underlying dynamics of phenomena that play out over time as stakeholders emerge and their contributions become essential to the opportunity formation process. The king crab data show that under conditions of uncertainty, characterized by incomplete or missing knowledge, entrepreneurial processes of experimentation, failure, and learning were effective in forming (...) and exploiting an opportunity. Moreover, contrary to existing literature that either emphasizes heroic entrepreneurs or downplays their value, this article shows that both the vision of the entrepreneur and the stakeholder contributions are critical. This detailed examination of process data shows that the cumulative actions made by entrepreneurs in concert with their stakeholders formed an opportunity that coalesced into a new market. (shrink)

Feelings associated with grief are regularly described as painful, but in what respect are they to be understood as pain? The acute pain of easily located tissue damage has long been the paradigm of pain in scientific and philosophical analysis, a dominance serving to obscure features the pain of grief might share not only with chronic pain but with some depressive suffering. Two examples of such commonalities are explored (ways pain feelings are experienced as in and of the body; and (...) are often recessed to the background of consciousness). These features are introduced to illustrate how a preliminary search for additional pain paradigms might proceed, and in so doing to offer some support for the proposal that pain endured as part of grieving may be real pain, not merely 'pain'. (shrink)

Feminist metaphysics is simultaneously feminist theorizing and metaphysics. Part of feminist metaphysics concerns social ontology and considers such questions as, What is the nature of social kinds, such as genders? Feminist metaphysicians also consider whether gendered perspectives influence metaphysical theorizing; for example, have approaches to the nature of the self or free will been conducted from a masculinist perspective, and would a feminist perspective yield different theories? Some feminist metaphysicians develop metaphysical theories with the aim of furthering certain social goals, (...) such as gender equality. Despite these and other intriguing research projects, feminist metaphysics faces challenges from two flanks: one might argue that "feminist metaphysics" is not metaphysics, or one might argue that it is not feminist. Recently, Elizabeth Barnes has made the case that, since contemporary accounts of the nature of metaphysics focus primarily on the fundamental, they have the problematic implication that feminist metaphysics is not, properly speaking, metaphysics. However, less emphasis has been paid, of late, to the idea that major strands of feminist thought also problematize feminist metaphysics. I will briefly assess the metaphysician's case against feminist metaphysics in Section 2 of this chapter. Then, in Section 3, I will examine in more detail possible feminist concerns over metaphysics. In Section 4, I sketch a different conception of metaphysics that avoids both mainstream and feminist challenges to feminist metaphysics. (shrink)

In this collection of original essays, international scholars put Asian traditions, such as Hinduism, Buddhism, Daoism, and Confucianism, into conversation with one or more contemporary feminist philosophies, founding a new mode of inquiry that attends to diverse voices and the complex global relationships that define our world. -/- These cross-cultural meditations focus on the liberation of persons from suffering, oppression, illusion, harmful conventions and desires, and other impediments to full personhood by deploying a methodology that traverses multiple philosophical styles, historical (...) texts, and frames of reference. Hailing from the discipline of philosophy in addition to Asian, gender, and religious studies, the contributors offer a fresh take on the classic concerns of free will, consciousness, knowledge, objectivity, sexual difference, embodiment, selfhood, the state, morality, and hermeneutics. One of the first anthologies to embody the practice of feminist comparative philosophy, this collection creatively and effectively engages with global, cultural, and gender differences within the realms of scholarly inquiry and theory construction. -/- http://cup.columbia.edu/book/978-0-231-16624-9/asian-and-feminist-philosophies-in-dialogue. (shrink)

Dispositions and potentialities seem importantly similar. To talk about what something has the potential or disposition to do is to make a claim about a future possibilitythe "threats and promises" that fill the world (Goodman 1983, 41). In recent years, dispositions have been the subject of much conceptual analysis and metaphysical speculation. The inspiration for this essay is the hope that that work can shed some light on discussions of potentiality. I compare the concepts of disposition and potentiality, consider whether (...) accounts of these concepts are subject to similar difficulties, and whether having a disposition or a potentiality can depend on extrinsic factors. The concept of a disposition I am working with is drawn from the recent literature in metaphysics and philosophy of science that focuses on the analysis of dispositional concepts and their role in a broader ontology. The concept of a potentiality is drawn from the bioethics literature that focuses on the moral relevance of potentialities that subjects of medical decisions mayor may not possess. Some preliminary conclusions I draw are the following: I. Potentialities are dispositions; 2. Due to problematic cases, potentiality ascriptions, like disposition ascriptions, are not reducible to counterfactual statements; and 3. Like dispositions, some potentialities can be extrinsic. Here I do not aim to draw any conclusions about the moral relevance of potentialities but rather to outline conceptual and metaphysical options available to those who seek to employ this concept. However, to the extent that these options are relevant to answering moral questions, I am skeptical about the prospects of finding a value-neutral way to choose between them. I have tried to outline a number of options regarding the nature of potentialities for those who would like that notion to play some role in their theorizing in bioethics, or elsewhere. There still are a number of decisions to make about how to explicate the concept of potentiality that is most relevant for one's purposes. How should one flesh out the associated counterfactuals, regardless of whether they hope to reduce potentiality claims to counterfactual conditionals? How should one circumscribe the relevant possible circumstances of manifestation for a given potentiality? Are the circumstances necessary for the actualization of a given potentiality to be counted circumstances of possession or circumstances of manifestation? Is the kind of which something is potentially a member a natural kind or a class whose membership is determined by convention? My anticipation, and perhaps my worry, is that these questions do not have answers that can be determined independently from the conclusions about the moral relevance of potentiality that a given theorist aims to establish. (shrink)

Without proper recognition of the dual pandemics of COVID-19 and racism that Asian Americans and other racial minorities in the United States are facing, we cannot successfully address structural b...

No matter how unintuitive it might seem that aesthetic pleasure should be the point where art and morality meet, this is a noteworthy possibility that has been overshadowed by aestheticians’ more visible concerns. Here I briefly survey relevant strands in the literature over the past century, before introducing themes covered in this inaugural issue of Australasian Philosophical Review.

When faced with an ambiguous pronoun, comprehenders use both multimodal cues and linguistic cues to identify the antecedent. While research has shown that gestures facilitate language comprehension, improve reference tracking, and influence the interpretation of ambiguous pronouns, literature on reference resolution suggests that a wide set of linguistic constraints influences the successful resolution of ambiguous pronouns and that linguistic cues are more powerful than some multimodal cues. To address the outstanding question of the importance of gesture as a cue in (...) reference resolution relative to cues in the speech signal, we have previously investigated the comprehension of contrastive gestures that indexed abstract referents – in this case expressions of personal preference – and found that such gestures did facilitate the resolution of ambiguous statements of preference. In this study, we extend this work to investigate whether the effect of gesture on resolution is diminished when the gesture indexes a statement that is less likely to be interpreted as the correct referent. Participants watched videos in which a speaker contrasted two ideas that were either neutral or moral acceptable). A gesture to the left or right side co-occurred with speech expressing each position. In gesture-disambiguating trials, an ambiguous phrase was accompanied by a gesture to one side or the other. In gesture non-disambiguating trials, no third gesture occurred with the ambiguous phrase. Participants were more likely to choose the idea accompanied by gesture as the stimulus speaker’s preference. We found no effect of scenario type. Regardless of whether the linguistic cue expressed a view that was morally charged or neutral, observers used gesture to understand the speaker’s opinion. This finding contributes to our understanding of the strength and range of cues, both linguistic and multimodal, that listeners use to resolve ambiguous references. (shrink)

This work offers a study on the problematic of a scientific knowledge of the sensible reality in the Enneads.

In this introduction to the edited volume, we briefly describe some of the current challenges faced by public mental health initiatives, at both the national and global level. We also include several general remarks on interdisciplinary methodology in public mental health ethics, followed by short descriptions of the chapters included in the volume.

I examine a passage from Heidegger’s 1922 overview of a proposed book on Aristotle wherein he addresses the importance of Aristotle’s treatment of accidental (sumbebēkos) causes in the Physics II.4-6. My analysis shows that this passage plays a key role within the account of Aristotle’s ontology presented in the overview insofar as it allows Heidegger to open up a new way of reading Aristotle, one that both diagnoses and pushes through the inheritance of being understood as technē in order to (...) retrieve originary insights about the movement of factical human life, world, and care. Rather than subordinate tuchē and automaton (chance) to the four ‘real’ causes they would remain merely incidental to or derivative of, Heidegger asks that we recognize the priority of praxis, whose archē unfolds as care toward and within a world of accidents. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 57-62 [Access article in PDF] Listening to People Or Listening to Prozac?Another Consideration of Causal Classifications Jennifer Hansen Keywords causal classification, descriptivism, melancholia, neurasthenia, depression, cultural relativism. The shape and detail of depression have gone through a thousand cartwheels, and the treatment of depression has alternated between the ridiculous and the sublime, but the excessive sleeping, inadequate eating, suicidiality, withdrawal from social (...) interaction, and relentless despair are all as old as the hill tribes, if not as old as the hills. In the years since man achieved the capacity for self-reference, shame has come and gone; treatments for bodily complaints have alternated and crossed with treatments for spiritual ones; pleas to external gods have echoed pleas to internal demons. To understand the history of depression is to understand the invention of human being as we now know and are him. Our Prozac-popping, cognitively focused, semi-alienated postmodernity is only a stage in the ongoing understanding and control of mood and character. (Solomon 2001, 286) ALTHOUGH ANDREW SOLOMON clearly believes that "the shape and detail of depression have gone through a thousand cartwheels," Jennifer Radden gives us pause before assuming that depression is just another name for Dame Melancholy. Solomon's claim depends on a deeper metaphysical claim about the nature of depression and its causes. The current method of psychiatric nosology, descriptivism, does not necessarily support equating melancholia and depression. Furthermore, it appears that adopting descriptivism as the sole method of classifying mental disorders commits us to cultural relativist psychiatry. Below I reconsider whether we want to rule out causal classifications and suggest that embracing both descriptivism and causal classifications offer us greater possibilities in understanding human illness and culture.Although the occasion for Jennifer Radden's essay is to investigate whether or not melancholia and depression refer to the same thing, her essay detours into a consideration of extra-descriptivist models of psychiatric illness versus the descriptivism of current psychiatric nosology. This detour turns out to be warranted; her purely academic question yields to a timelier question concerning the proper methodology for classifying mental disorders. Whereas debates about psychiatric nosology are perennial, the recent success of the new generation of antidepressants [End Page 57] is reviving biological psychiatry and its search for the neurochemical origins of depression. Hence, embedded in Radden's question concerning whether or not melancholia is the same thing as clinical depression, is another important question concerning the causes of mental illness, particularly depression.Currently, with its descriptivist approach, the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not classify mental illness, such as clinical depression, based on underlying causes. The cluster of symptoms and behavioral signs that lead a clinician to diagnose one as depressed that are contained in either the DSM or the International Classification of Diseases (ICD) may be too fuzzy or elusive to give any clear distinction between major depression, mild depression, and the blues. For example, one group of epidemiologists points out that [t]he DSM-III, DSM-III-R, and DSM-IV acknowledge that depression, like many mental disorders, has no currently obvious natural classes... If natural classes of depression exist, then their nosology awaits the discovery of distinct and reliable genetic, biological, clinical, or other predictors of risk, severity, or clinical course. Clinicians have a tradition of separating depressions into subtypes; however, this subtyping has not yet led to clear-cut delineations of syndromes in populations. (Kaelber 1995, 4) The evidence is still insufficient to establish the biological or psychological origins of depression. Although many theories exist that explain why people become depressed, scientifically we are not yet in a position to determine which is the right theory. From a pragmatic perspective, however, whether or not we know what causes depression, we can nonetheless attempt to alleviate suffering from depression. And it is with this goal in mind that the DSM-IV and ICD-10 classify mental disorders.Now, given that our current methodology for psychiatric nosology does not establish causes, it is also insufficient for determining what... (shrink)

Background: Not all patients are considered equal. For patients who are considered to be “very important persons,” care can be different from that of other patients with advantages of greater access to resources, special attention from staff, and options for luxurious hospital amenities. While very important person care is common and widely accepted by healthcare administration, it has negative implications for both very important person and non-very important person patients, supports care disparities and inequities, and can create serious ethical dilemmas (...) for healthcare professionals. Very important person care can also result in negative care outcomes for its recipients. Objective: This article sought to explore the implications and ethical considerations of very important person care within the context of United States healthcare system, and integrate bioethical principles and American Nurses Association Code of Ethics for Nurses to influence recommendations for managing ethical dilemmas associated with very important person care. Method: A synthesis of the literature on very important person care was undertaken for this article. Ethical considerations: Ethical conduct was considered and respected when performing the literature review, referencing sources, and establishing authorship. Findings: According to the published literature, very important person care bares both positive and negative implications for patients, and negative implications for nurses. Nurses are the most affected by the demands from their administrators to provide special care and attention to patients in the “very important person” category and their families. Very important person care can be disruptive, disorienting, challenging, and stressful to nurses. Conclusion: While physicians and other healthcare professionals have commented on very important person care, limited work has been done in nursing. There have not been any empirical studies on very important person care. Therefore, in order to minimize the negative implications of very important person care, studies of this phenomenon are warranted. Exposing very important person care is important in the development of an ethical healthcare system. Moreover, understanding the ethical principles surrounding the concept of very important person care will empower nurses to effectively manage conflicts and ethical dilemmas that arise with very important person care. (shrink)

Over the last decade, numerous interventions and techniques that aim to engender, strengthen, and expand compassion have been created, proliferating an evidence base for the benefits of compassion meditation training. However, to date, little research has been conducted to examine individual variation in the learning, beliefs, practices, and subjective experiences of compassion meditation. This mixed-method study examines changes in novice meditators’ knowledge and contemplative experiences before, during, and after taking an intensive course in CBCT®, a contemplative intervention that is increasingly (...) used for both inter- and intrapersonal flourishing. The participants in this study were Christian healthcare chaplains completing a 1-year residency in Clinical Pastoral Education who learned CBCT as part of their professional chaplaincy training curriculum. Prior to and upon completion of training, we surveyed participants to assess their beliefs about the malleability of compassion, types of engagement in compassion meditation, and perceptions of the impact of taking CBCT. We also conducted in-depth interviews with a subset of participants to gain a qualitative understanding of their subjective experiences of learning and practicing compassion meditation, a key component of CBCT. We found that participants reported increases in the extent to which they believed compassion to be malleable after studying CBCT. We also found high levels of variability of individual ways of practicing and considered the implications of this for the study of contemplative learning processes. This multi-methodological approach yielded novel insights into how compassion practice and compassion-related outcomes interrelate, insights that can inform the basic scientific understanding of the experience of learning and enacting compassion meditation as a means of strengthening compassion itself. (shrink)

: Extreme pain and suffering are associated with depression as well as tissue damage. The impossibility of imagining any feelings of pain and suffering intersect with two matters: the kind of imagining involved, and the nature of delusions. These two correspond to the sequence of the following discussion, in which it is contended first that feelings of pain and suffering resist being imagined in a certain, key way, and second that, given a certain analysis of delusional thought, this precludes the (...) possibility of delusional affections while allowing delusions about affections. Keywords: Pain; Imagination; Delusion; Affection; Feelings Dolore immaginato e dolore illusorio Riassunto: Dolore estremo e sofferenza sono solitamente associati a depressione e danni tissutali. L’impossibilità di immaginare il provare dolore e sofferenza dipende da due fattori: il tipo di immaginazione coinvolta e la natura dell’illusione. Questi due fattori saranno trattati in parallelo nell’analisi che qui si propone, in cui si discuterà in primo luogo come il provare dolore e sofferenza oppongano resistenza all’essere immaginati in un certo modo e in secondo luogo come, secondo una certa analisi del pensiero illusorio, questo preclude la possibilità di affezioni illusorie mentre consente illusioni circa le affezioni. Parole chiave: Dolore; Immaginazione; Illusioni; Affezione; Sensazioni. (shrink)

This paper is a critical examination of Daryl Close’s “Fair Grades” . I dispute his view regarding the implications of accepting the purpose of grades as being fundamentally informational. I draw upon data identifying behaviors conducive to success and Carol Dweck’s work to argue for broadening what can be taken into account for a final grade. I argue that the informational purpose of final grades is preserved if we grade with an eye to encouraging general skills and dispositions conducive to (...) success. Also, grading as Close recommends will discourage learning whereas using grades to reinforce positive behaviors is a fulfillment of our responsibility to enhance learning. I also address Close’s claims that curved grading and grade penalties for academic dishonesty are unfair and argue that neither of these practices necessarily corrupts final grades. (shrink)

The peptide hormone oxytocin plays a critical role in regulating affiliative behaviors including mating, pair‐bond formation, maternal/parenting behavior, social recognition, separation distress and other aspects of attachment. Jin and colleagues1 recently reported intriguing findings that CD38, a transmembrane receptor with ADP‐ribosyl cyclase activity, plays a critical role in maternal nurturing behavior and social recognition by regulating oxytocin secretion. This research may have implications for understanding disorders marked by deficits in social cognition and social functioning, including autism, social anxiety disorder, borderline (...) personality disorder and schizophrenia. BioEssays 29:837–841, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

John Cooper and Pierre Hadot suggest that contemporary philosophy can no longer be regarded as a way of life as it has become an academic discipline of study that is theoretical and abstract. According to them, for philosophy to be considered a way of life, it has to be able to shape one’s understanding of the world, guide how one should respond from moment to moment, and reach an existential level in defining one’s being. In this article, I discuss how (...) Jean-Paul Sartre’s existentialist philosophy is a way of life that has been overlooked by Cooper and Hadot. I show that Sartre’s existentialism presents an interconnected perspective of human existence and human development in history, is able to guide our philosophical reasoning about our everyday decisions, and offers a practical guide to living an authentic life through assuming responsibility for our life choices and engaging with our situations. (shrink)

Sixteen-hundred years ago, Augustine begged his African congregants to think rationally, pay attention to evidence, and listen to their neighbors. He knew this would not be easy. He knew that human error is more common than human knowledge. He himself had been a member of an elitist cult for nearly ten years and then had spent several years as a skeptic resigned to seeking wealth and honors rather than hoping for truth or goodness. He would not be surprised by the (...) rise of white supremacist cults or the nihilistic apathy that have arisen in the ""post truth"" era. He had seen nativism, elitism, fear, and doubt rise in response to a crisis of hope that truth could be found, a crisis that led to the use of physical force rather than educated disputation, a crisis that ended in the fall of both Rome and Carthage to Vandals and Visigoths. Augustine's response was to preach publically the hope that encouraged him in his own personal quest for a happy life. This book examines that hope in Augustine's context until the current moment. (shrink)